MEDICARE: ECLIPSE HOME HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	2004HHA35654	UT

General Provider Information

NPI Number	:	1902801657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECLIPSE HOME HEALTH INC

Provider Business Mailing Address
First Line	:	746 E WINCHESTER ST
Second Line	:	G10
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-8512
Country	:	US
Telephone Number	:	801-293-1199
Fax Number	:	801-293-1224

Provider Business Practice Location Address
First Line	:	746 E WINCHESTER ST
Second Line	:	G10
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-8512
Country	:	US
Telephone Number	:	801-293-1199
Fax Number	:	801-293-1224

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DIANA LEE GOURLEY
Credential	:	RN
Telephone Number	:	801-293-1199

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	05/01/2009

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